Health Advisory: Increase in Severe Mushroom Poisonings in the San Francisco Bay Area

Disease Prevention and Control

Situational Update:

Between November 18, 2025, and February 9, 2026, 40 cases of amatoxin poisoning from eating wild poisonous mushrooms have been reported in California, including in the San Francisco Bay Area, resulting in four deaths and three liver transplants to date. Patients ingested Death Cap (Amanita phalloides) or related mushrooms, which resemble edible varieties and are highly toxic. Cooking, boiling, drying, or freezing does not neutralize the toxin. Pets are also at risk; several dog deaths have been reported. SFDPH urges the public to not pick or eat wild mushrooms during this time of increased risk and avoid eating wild mushrooms picked by friends or family. The California Department of Public Health (CDPH) has a dashboard and a public webpage with more information about the current outbreak.

Symptoms typically occur in stages, and clinical severity can vary depending on the patient and amount of ingested mushroom (times listed after ingestion):

  • 6–24 hours: onset of vomiting, severe abdominal cramps, watery diarrhea
  • 18–36 hours: symptomatic improvement; however, liver enzymes are often rising
  • 2-4 days: advanced liver injury, multiple-organ failure, acute kidney injury, convulsions
  • 6-16 days: death (in severe cases)

Actions Requested of Clinicians:

  1. Ask about mushroom ingestion in patients with acute GI symptoms or abnormal liver enzymes
  2. Monitor for triphasic presentation: initial GI illness, a false recovery phase, then hepatic deterioration
  3. Immediately contact California Poison Control System (1‑800‑222‑1222) if you have a suspected case for guidance on diagnosis and treatment
  4. Initiate early management:
    • Aggressive fluid resuscitation and electrolyte replacement
    • Consider IV silibinin (Legalon SIL) within 24 hours
    • Admit patients for monitoring; transfer to a transplant center if acute liver failure is suspected

Additional Resources

California Poison Control System (24/7): 1‑800‑222‑1222

CDPH Health Advisory: Severe, Potentially Fatal Liver Damage in Children and Adults Associated with Consumption of Foraged Wild Mushrooms – 12/5/25

CDPH Health Update: Severe illness or fatal liver damage caused by mushroom poisonings in California​​ – 1/15/26

View or sign up for SFDPH Health Alerts, Advisories, and Updates at sf.gov/healthalerts